When a patient is diagnosed with a kidney tumor, a number of treatment options should be considered:
- Observation is an option chosen many times for tumors that are very small or for tumors in patients that are not surgical candidates.
- Percutaneous ablative techniques (cryoablation or radio frequency ablation) are considered for tumors less than 3-4 cm. This technique allows for the destruction of the tumor through the skin under ultrasound guidance of computer tomography guidance by placing a long needle into the tumor and either destroying it via heat (radiofrequency ablation) or freezing (cryoablation). However, recent data suggest that cancer control can only be achieved in 75% of the cases.
- Surgical removal of the tumor, which leads to a cancer control rate of greater than 95% in the vast majority of patients.
If surgical removal is considered by you and your doctor as the best treatment option, there are several things to consider. The most important decision in regards to surgery is whether or not you are a candidate for a partial nephrectomy (removing only the portion of the kidney that contains the tumor). At Roswell Park, all efforts are directed at saving as much of the kidney as possible as studies have shown that the more kidney that remains, the better the outcome for the patient. If a partial nephrectomy can not be performed, a radical nephrectomy (removal of the entire kidney and some surrounding tissues) is the other surgical option.
Depending on the decision being made by you and your doctor, there are three different surgical methods that can be used to perform a partial nephrectomy. Depending upon your situation, the proper surgical technique will be chosen. The options are: robot-assisted partial nephrectomy, laparoscopic partial nephrectomy and open partial nephrectomy.
The robot-assisted option is detailed in depth on this site, while a laparoscopic surgery involves the use of a thin, flexible tube with a light and magnifying lens at the tip that allows the surgeon the ability to look into the abdomen. Both robot-assisted and laparoscopic surgeries are considered minimally invasive surgeries, meaning that very small incisions are used that allow for quicker healing. At Roswell Park, a minimally invasive approach (either robotic or laparoscopic) is used wherever possible. An open surgery is the other option, which utilizes a larger incision to access the abdomen and results in a slightly longer recovery time.
The primary objective in managing kidney tumors is preservation of functional kidney tissue which is feasible in our hands in 90% of all kidney tumors, independent from size, location, aggressiveness or stage. The majority (75%) of partial nephrectomies can be performed in a robotic/ laparoscopic fashion; although studies have shown and very steep learning curve amd outcomes can be surgeon volume dependent; the kidney cancer program at Roswell Park performed 100 robotic assisted laparoscopic kidney surgeries over the past 13 months and thus represents one of the highest volume robotic kidney surgery centers in the country.
It is important to stress that the treatment decision or surgical option you choose must be agreed upon with you and your doctor. The rest of this document will show the benefits associated with using the Da Vinci Surgical System (robot-assisted partial nephrectomy).
What is a robot-assisted radical nephrectomy?
Like any surgery, robot-assisted radical nephrectomy (RARN) takes place in an operating room that has been specially prepared for the procedure. The striking difference when you look into an operating room where an RARN is taking place is that the surgeon is not at the operating table. Instead, the surgeon sits at a high-tech station nearby, looking through a special viewer that displays a high-definition, 3-dimensional, magnified picture from the camera arm of the robotic device. The surgeon’s hands and feet operate controls that function somewhat like joy-sticks, only much more sensitive and complicated. These controls translate the surgeon’s movements to the robotic device and allow it to make the intricate, precise movements needed for this complex surgery.
Depending on the tumor size and other factors, the surgical options are as follows:
- Radical Nephrectomy: Removal of the entire kidney along with some tissue around the kidney.
- Partial Nephrectomy: The surgeon removes only the part of the kidney that contains the tumor. This technique is now established as a safe cancer control procedure. Data are available that document that patients undergoing partial nephrectomy have in fact a longer survival than patients undergoing a radical nephrectomy for the same tumor. This is true for all stages of kidney cancer, tumor locations and tumor stages. At Roswell Park, over 90% of all kidney cancer surgeries are performed as partial nephrectomies. The vast majority of these partial nephrectomies are performed as robotic assisted laparoscopic partial nephrectomies.
If a partial nephrectomy is agreed upon as your treatment option, it can be performed using the da Vinci® Surgical System. This system allows access to the patient’s abdomen through a key hole access procedure. The special camera system allows the surgeon a 3D high definition image of the tissues. The special robotic arms allow the surgeon a greater degree of motion than his or her natural wrist – yet in a miniaturized version.
Using hand and foot controls, the surgeon expertly manipulates the arms of the machine from the console to perform this intricate surgery. The machine has four arms. One arm has a high-definition camera. The other arms hold the special tools that are needed for the procedure. The tools on the robotic arms are thinner, more flexible, and more precise than the surgeon’s fingers—and they never get tired!
During the robot-assisted partial nephrectomy, your doctor carefully examines all of the tissue in the area of the kidney to make certain that there is no cancer located outside the organ. A laparoscopic ultrasound is used to locate and outline the tumor.
Advantages of robot-assisted surgery
- Smaller incisions heal faster and with less pain, reducing the length of hospital stay and amount of narcotic pain medication used during recovery as compared to open surgery
- Studies report a smaller amount of bleeding during surgery as compared to open surgery, which decreases the risk of needing a blood transfusion
- Three-dimensional viewing and 10x magnification can make surgical technique more precise over standard laparoscopy
- The ability of the robotic instruments to rotate within the abdomen may allow quicker repair of the remaining kidney, which may allow it to function better